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813 -780 -0020 City of Zephyrhills Fire Fax- 813-780 -0021 .
<br /> Permit Application
<br /> Date Received f l Phone Contact for Permit j (.1:::=w .N.. •
<br /> Owner's Name 2_6, Li &Ili t 6,./A-12, Z I Owner's Phone Number
<br /> Owner's Address t i V 3 0 ze, S r F e r,V Xza (� /- 7 L
<br /> ( 3 3' V
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Titleholder Address
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<br /> Job Address Lot #
<br /> Sub Division Parcel #
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<br /> Bio- Hazard Waste Storage - ANNUAL [ Fumigation Tent
<br /> EI Comm Exhaust Kitchen Hood /Duct nI Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> I I Controlled Bum I I Hood Installation
<br /> Emergency Generator < 30 kw J 1 LP /Natural Gas - Installation
<br /> I — I Emergency Generator> 30 kw El LP /Natural Gas - ANNUAL Sale
<br /> r -- 1 II Fire Protection Maintenance - ANNUAL r --- 1 Places of Assembly- ANNUAL zej IUtrlyl ISemi ) 7 Uther
<br /> Sprinkler ❑ ❑ n Recreational Bum
<br /> Fire Alarm n ❑ ❑ ❑ I 1 n Sparklers
<br /> Hood Cleaning 0 ❑ ❑ ❑ I I n Sprinkler System Installations
<br /> Hood Suppression ❑ ❑ ❑ I I I I Standpipes (Sprinkler Sys)
<br /> II Fire Alarm Installation I I Torch Roofing/Tar Kettle
<br /> ® Fire Pumps 4- A/./U4 ,.' L/ -
<br /> .vew n Waste Tire Storage ANNUAL
<br /> El Fire Works
<br /> n Flammable Application- ANNUAL
<br /> 1 I Valuation of Project
<br /> I—I Fuel Tanks
<br /> 7 Other: 1
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<br /> Contractor Company I
<br /> Signature Registered Y / N I Fee Current I Y/ N I
<br /> Address I License # I
<br /> ELECTRICIAN Company I
<br /> Signature Registered Y/ N I Fee Current I Y / N I
<br /> Address I I License # I
<br /> PLUMBER Company I
<br /> Signature Registered Y / N I Fee Current I Y / N I
<br /> Address I I License # I
<br /> MECHANICAL Company I
<br /> Signature Registered Y / N I Fee Current I Y / N I
<br /> Address I I License # I I
<br /> OTHER Company I
<br /> Signature Registered Y / N I Fee Current I Y / N I
<br /> Address lI 1 License # I
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<br /> Directions:
<br /> Fill out application completely.
<br /> Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner)
<br /> If over $2500, a Notice of Commencement is required (Mechanical work over $5000)
<br /> Supply two (2) sets of drawings with applicable documentation
<br /> Allow 10 -14 days for review after submittal date. Parcel # - obtained from Property Tax Notice (http: / /appraiser.pascogov.com)
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